Regional Medical Director

Purpose :

Community Care Behavioral Health (CCBH) is seeking a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The Regional Medical Director is responsible for assuring the quality and efficiency of the health care delivered to Community Care members. This includes significant responsibility for quality management and utilization management and for assuring the adequacy of the provider network for the clinical needs of Community Care members. The Medical Director also participates in regional leadership policy decisions and strategic planning. In addition, the Regional Medical Director is a resource to participating providers in the provision of quality medical care. The Regional Medical Director would join a highly educated and motivated team of physician advisors at CCBHO who advocate well for the recovery from mental health and substance use disorders for nearly a million individuals across Pennsylvania. He or she would have the opportunity to be involved in many new initiatives some of which lend towards research and journal inclusion.

This position is Hybrid and will require an in-person presence in Media, PA at least 2 days per week. The selected candidate will have some flexibility in their schedule availability (28 / hrs weekly)

Responsibilities :

• Reviews of complaints and grievances in accordance with Community Care procedures, and to assure prompt response and action at all stages of the complaint and grievance process.
• Works with Provider Relations to enhance the working relationship between Community Care and the providers in its network.
• Ensures the quality of clinical care provided to Community Care members.
• Focus on quality and utilization from a regional perspective to include UPMC Passavant and UPMC St. Margaret.
• Assures the quality of treatment and related services provided by Community Care professional staff, through participation (directly or by designee) in the ongoing quality management and audit processes.
• Interfaces with physician consultants and provides direction for the physician consultants. Interfaces with the Physical Health MCO's through Medical Director to Medical Director meetings and sits on appropriate committees of the PH MCOs.
• Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System.
• Acts as a liaison for Community Care with community physicians, hospital staff, and other professionals and agencies with regard to psychiatric services.
• Serve as advisor to quality departments from a regional perspective.
• Supports member satisfaction with the care management process.
• Implements quality management programs and continuing education activities.
• Develops and maintains effective relationships with providers.
• Serves as physician advisor for UPMC Passavant McCandless and UPMC Passavant Cranberry and serves as a backup for other business units
• Advises the Regional Director on the development and review of programs, positions, and budgets having an impact on clinical services.
• Effectively reduce observation rates, length of stay, and readmission rates.
• Work in tandem with the UPMC Health Plan.
• Acts as a physician reviewer for cases referred by care management staff.
• Focus on clinical documentation improvement efforts thereby improving reimbursement rates.
• Interfaces with the Counties and DPW as indicated.
• Works with Quality Management in designing and evaluating protocols.
• Assures effective and appropriate utilization of the various levels of care in the provider network.
• Meets or exceeds NCQA, URAC or other regulatory standards.
• Participates in the appropriate committees of physical health HMO's where applicable, such as a pharmacy and therapeutics committee.
• Works closely with the medical directors of physical health HMO's to assure coordination between physical health and behavioral health needs and services.

Qualifications :

Minimum 10 years clinical experience required.

Licensure, Certifications, and Clearances :

Doctor of Medicine or Doctor of Osteopathy

UPMC is an Equal Opportunity Employer / Disability / Veteran